1254 ANNUAL REPORT OF THE COMMISSIONERS IN LUNACY FOR SCOTLAND.

plague and one death last week." The great event in the lrecent sanitary history of Hong-Kong has been the declara- ition of the principal civil medical officer on Sept. 20th at themeeting of the Sanitary Board that we may take it thatplague is now endemic in the colony." The Government hasdone nothing, however, to prevent the overbuilding which isallowed to proceed unchecked.Plague has practically ceased in Egypt; there were

only three cases at Alexandria during the month of Sep-tember and no case has appeared there since Oct. 1st.The Marquis of Salisbury has received a despatch fromViscount Cromer, dated Oct. 12th, on the subject of theplague at Alexandria and enclosing a report from Sir JohnRogers, the late head of the sanitary department. In theopinion of the latter official" all fears of a winter epidemicmay now be dismissed, though isolated cases may occur."With this view Lord Cromer concurs and in a telegram datedOct. 22nd he adds that Alexandria had been free from freshcases for three weeks. The manner in which the sanitaryofficials have dealt with this outbreak is highly commendable.The first case occurred in May and altogether 92 cases werediscovered. 45 of these patients died. With the exception oftwo cases at Damanhoor, 40 miles to the south, all occurredat Alexandria. Not a single case was heard of at Cairo or inUpper Egypt. Nothing could be more creditable. The lasttime the plague effected an entrance into Egypt in 1834 thevictims were to be numbered by the thousand.The last weekly returns from Oporto showed 29 fresh cases

and eight deaths, bringing up the total numbers since theoutbreak of the disease to 209 cases and 72 deaths.There has been an outbreak of plague in Brazil. Accord-

ing to the earlier telegraphic information from Rio deJaneiro great doubts were expressed locally, however, asto the veritable nature of the disease. A telegram fromRio de Janeiro on Oct 22nd stated that the totalnumber of cases of plague at Santos amounted to fivesuspicious cases, including two fatal ones. The authorities,both Federal and State, have taken the most stringentmeasures to localise the outbreak. The local physicians atthe time attributed the reported cases to adenitis, which isfrequent at this season of the year. The Sao Pauloauthorities, however, believed in the existence of the plague,and the presence of bubonic plague was officially admitted.A telegram from Rio de Janeiro of Oct 30th states that thehospital at Santos has 11 cases of plague, of which nine areof a mild character. From Oct. 17th to the presentdate there have been five deaths from the disease. The

report that the disease has broken out at Sao Paulo iscontradicted.A telegram was received at the Colonial Office from the

Mauritius to the effect that for the week ending Oct. 19ththere were 89 fresh cases of plague, 57 fatal, with a totalplague death-rate of 72 during the week.

THE ANNUAL REPORT OF THE COMMIS-SIONERS IN LUNACY FOR SCOTLAND.

THIS report is now before us and covers the year 1898.At the beginning of the present year there were 15,399lunatics in Scotland under official cognisance, and of these13,006 were maintained out of parochial rates and 48 at theexpense of the State. The general results regarding theinsane in Scotland during the year 1898 as compared with1897 were as follows. There was a total increase of 487registered lunatics, of whom 438 were paupers and 49 wereprivate patients. The average annual increase in the number Iof pauper patients in the five years 1891-95 was 194, andit will be seen in comparison with this that the increase

during the past year has risen enormously above the

average annual increment for the previous quinquenniad.Examining the increase carefully, and with reference to

the various counties, it is found that most of the countiesshow a rise in numbers of the insane. Fife contributes anincrement of 27, Ayr of 34, and Aberdeen of 54, while

Edinburgh contributes 65 and Lanark the exceptionally largenumber of 95. It is instructive to follow the increase of

lunacy in Argyll as pointed out in the report. In 1861 thenumber of its pauper lunatics in proportion to the generalpopulation was much the same as for the rest of Scotland." Since that year," say the Commissioners, " the proportion

has, with hardly a pause, risen steadily and so rapidly thatit has more than doubled the number of its patients in theasylum since 1876, and notwithstanding the great rise ofnumbers in other counties it now stands (in regard to the pro-portion of its asylum lunatics to population) much beyondany county in Scotland." Attempts at explanation have beenmade, but allowing for all circumstances the conclusionappears to be certain that a considerable and actual increaseof insanity is taking place.The discharges present no feature of special interest or

importance. The number of cases discharged as "recovered"during the year amounted to 1293 for pauper patients and69 for private patients. The total recoveries-private andpauper patients inclusive-thus amounted to 9 24 per cent.of the average number of patients resident during the year,which number was 14,735.The total percentage of deaths calculated on the same

basis amounted to 7 34 per cent. of the average annualpopulation.The Commissioners draw attention in grave terms to the

overcrowding which prevails in many asylums, and amongthose referred to are the Royal Asylums at Aberdeen, Edin-burgh, and Montrose, and the Banff District Asylum. Theyalso advert to the system of night nursing and supervision ofpatients, both suicidal and non-suicidal, in regard to whichthere is room for extension and improvement.The subject of pulmonary tuberculosis in the asylum

population, to which attention has already been directedin these columns, 1 is referred to in weighty wordsby the Commissioners. They point out the extreme

liability of the insane to tuberculous disease and empha.sise the fact that " the conditions of asylum life,especially in institutions which are overcrowded, are inthemselves likely in a high degree to originate and tospread such disease, ...... that patients should be placed inspecial wards and every precaution taken to prevent the riskof disease being spread through sputum, &c., ...... and thatthe authorities of asylums shculd take every means in theirpower to ensure that the milk supplied to the patients iswholesome and produced under healthy conditions, whetherit is derived from cattle kept on asylum farms or is obtainedfrom sources external to the asylum."

ROYAL COLLEGE OF PHYSICIANS OFLONDON.

AN ordinary meeting of the Comitia was held on

Oct. 26th, Dr. WILLIAM SELBY CHURCH, President, beingin the chair.The following gentlemen were admitted Members of the

College :-Edward Farquhar Buzzard, M.A., M.B.Oxon.;Williams Herbert Davis, M.A., M.B. Oxon., L.R.C.P. Lond. ;Thomas Frederick Gardner, L.R O.P.Lond.; Daniel West

Samways, M.A., M.D. Cantab., L.R.C.P. Lond.; Robert

Sevestre, M.A., M.D. Cantab., L.R.C.P. Lond. ; and EdwardStainer, M.A., M.B. Oxon.

Licences were granted to 122 gentlemen who had passedthe required examinations.Commanications were received from : 1. Mr. Edward

Trimmer reporting certain proceedings of the Councilof the Royal College of Surgeons of England. 2. FromDr. J. F. Payne offering to the College a medal,cast to celebrate the presentation of a bust of Morgagnito St. Thomas’s Hospital by a committee of Italian

physicians chiefly resident in Milan. On one side of themedal is a representation of the head of Morgagni andon the reverse a suitable inscription. 3. From Dr. Payneresigning his place on the Laboratory Committee in conse-quence of his having been elected Harveian Librarian.4. From the University of London Commission acknowledg-ing the receipt of a communication from the College.The audited accounts for the year ending Sept. 29th last

were received and adopted, as was also the quarterly reportof the Finance Committee. In connexion with these reportsDr. THEODORE WILLIAMS announced his intention of pre-senting <E1000 to the Endowment Fund of the College.-ThePRESIDENT thanked Dr. Williams in the name of the College

1 THE LANCET, July 15th, 1899, p. 167.

1255VITAL STATISTICS.-THE SERVICES.

for his most generous gift and hinted that others might beinduced to take a like action.A report was received from Dr. Radcliffe Crocker on the

International Conference on the Prevention of VenerealDiseases, held at Brussels in September last.-The PRE-SIDENT thanked Dr. Crocker for having represented theCollege.

Dr. W. S. Church was re-elected a representative of theCollege on the Council of University College, Bristol.A report was received from the Committee of Management

dated Oct. 9th. Amongst other matters dealt with it wasannounced that the committee recommend that theRochdale Municipal Technical School be added to the listof institutions recognised by the Board as a place of instruc-tion in chemistry, physics, and practical chemistry. Dr.Edward Liveing who retired by rotation from the committeewas re-elected on the motion of Dr. NORMAN MOORE,seconded by Dr. VIVIAN POORE.The SENIOR CENSOR (Dr. PYE-SMITH) proposed, and the

REGISTRAR (Dr. LIVEING) seconded, that Dr. W. D. Halli-burton be re-elected a member of the LaboratoriesCommittee.This was agreed to.The REGISTRAR moved for the second time that By-law

163 be altered so as to read as follows :-The fee to be paid for admission as a Member of the College shall be

40 guineas except when the candidate for the Membership is a Licen-tiate of the College, in which case the fee already paid for the Licenceshall be deducted from the 40 guineas.This was seconded by the SENIOR CENSOR and adopted.The quarterly report of the examiners for the Licence was

received and adopted.After some further formal business the PRESIDENT dis-

solved the Comitia.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 33 of the largest English towns 6545 births and 462:deaths were registered during the week ending Oct. 28thThe annual rate of mortality in these towns, which ha(been 18’6 and 19-0 per 1000 in the two preceding weeksfurther rose last week to 21’1, and was identical with the deathrate in London, and with the mean rate in the 32 provinciatowns. The lowest death-rates in these towns were 10’1 irCardiff, 12’7 in Croydon and in Derby, 13’4 in Norwich, anc14’0 in Plymouth. The highest rates were 24’8 in Salford.27 3 in Sheffield, 27-7 in Liverpool, and 29-7 in Bristol.The 4623 deaths in these towns included 487 which werereferred to the principal zymotic diseases, against 436 and457 in the two preceding weeks; of these, 130 resulted fromdiphtheria, 98 from measles. 93 from "fever" (principallyenteric), 89 from diarrhoea, 37 from whooping-cough, 36 fromscarlet fever, and four from small-pox. The lowest death-rates from these diseases were recorded in Plymouth, Cardiff,Derby, Preston, and Halifax; and the highest rates inPortsmouth, Swansea, Birkenhead, Salford, Sheffield, andHull. The greatest mortality from measles occurred in

Nottingham, Birkenhead, Salford, and Sheffield ; fromscarlet fever in Burnley; from whooping cough in Gates-head ; from "fever" in Nottingham, Sheffield, and Sunder-land ; and from diarrhoea in Bristol, Wolverhampton,Liverpool, Manchester, Salford, and Gateshead. The 130deaths from diphtheria included 58 in London, 13 inSheffield, seven in Leeds, six in Portsmouth, six in Swansea,and six in Birmingham. Four fatal cases of small-pox wereregistered last week in Hull, but not one in any other of the33 large towns, and no small-pox patients were undertreatment in any of the Metropolitan Asylums Hospitals.The number of scarlet fever patients in these hospitalsand in the London Fever Hospital on Saturday last, Oct. 28th,was 3504, against 3003, 3217, and 3408 at the end of thethree preceding weeks; 414 new cases were admitted duringthe week, against 461, 455, and 447 in the three precedingweeks Influenza was certified as the primary cause

of 18 deaths in London. The deaths referred to diseasesof the respiratory organs in London, which had increasedfrom 133 to 306 in the five preceding weeks, further rose lastweek to 478, and were 160 above the corrected average. Thecauses of 56, or 1’2 per cent., of the deaths in the 33 townswere not certified either by a registered medical practitioneror by a coroner. All the causes of death were duly certifiedin Leicester, Manchester, Salford, Bradford, Leeds, and I’in 12 other smaller towns ; the largest proportions of i

uncertified deaths were registered in West Ham, Birmingham,Liverpool, Sheffield, and Hull.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 18-1 and 17-3 per 1000 in the two precedingweeks, rose again to 17’9 during the week ending Oct. 28th,.but was 32 per 1000 below the mean rate during the sameperiod in the 33 large English towns. The rates in the

eight Scotch towns ranged from 10 in Leith and 13’5 inPerth to 18’8 in Greenock and 20 3 in Glasgow. The 546.deaths in these towns included 27 which were referredto diarrhoea, nine to measles, eight to diphtheria, eight to’’ fever," six to scarlet fever, and one to whooping-cough. In.all, 59 deaths resulted from these principal zymotic diseases,against 75 and 63 in the two preceding weeks. These59 deaths were equal to an annual rate of 19 9 per 1000,which was 0’3 below the mean rate last week from thesame diseases in the 33 large English towns. Tne fatal casesof diarrhoea, which had decreased from 193 to 26 in theseven preceding weeks, rose again last week to 27, of which13 occurred in Glasgow, four in Edinburgh, three inDundee, and three in Paisley. The deaths from measles,which had been 15 and 13 in the two preceding weeks,further declined to nine last week and included eight-in Glasgow. The fatal cases of diphtheria, which hadbeen three and four in the two preceding weeks, furtherrose last week to eight, of which three were recordedin Edinburgh, two in Glasgow, and two in Greenock. Thedeaths referred to different forms of "fever," which hadbeen nine and 13 in the two preceding weeks, declined againto eight last week, and included four in Glasgow and two in.Dundee. The six fatal cases of scarlet fever correspondedwith the number in each of the two preceding weeks, andincluded three in Glasgow. The deaths referred to diseasesof the respiratory organs in these towns, which had been 102and 84 in the two preceding weeks, rose again to 108 lastweek, but were 11 below the number in the correspondingperiod of last year. The causes of 20, or nearly 4 per cent.,of the deaths in these eight towns last week were notcertified.

___

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 33 6 and 37’3per 1000 in the two preceding weeks, declined again to 36 4during the week ending Oct. 28th. Daring the past fourweeks the death-rate in the city has averaged 34’1per 1000, the rate during the same period being 19’0 inLondon and 17-7 in Edinburgh. The 244 deaths registeredin Dublin during the week under notice were six belowthe number in the preceding week, and included 63which were referred to the principal zymotic diseases, against68 and 64 in the two preceding weeks ; of these, 44 resulted-from measles, nine from diarrhoea, seven from "fever," twofrom diphtheria, one from scarlet fever, and not one eitherfrom small-pox or whooping-cough. These 63 deaths wereequal to an annual rate of 9-4 per 1000, the zymotic death-rate during the same period being 2-0 in London and 1’6 inEdinburgh. The deaths resulting from measles, which hadbeen 44 and 52 in the two preceding weeks, declinedagain last week to 44. The fatal cases of diarrhoea, whichhad decreased from 27 to four in the four preceding weeks,rose again to nine last week. The deaths referred to-different forms of fever, which had been seven and four inthe two preceding weeks, rose again last week to seven.

The mortality both from measles and from scarlet fevercorresponded with that in the preceding week. The 244-deaths in Dublin last week included 45 of infants underone year of age and 55 of persons aged upwards of 60years ; the deaths of infants exceeded the numbers recordedin the preceding week, while those of elderly persons showeda decline. Nine inquest cases and eight deaths from violencewere registered; and 79, or nearly a third, of the deaths.occurred in public institutions. The causes of 13, or morethan 5 per cent. of the deaths in the city last week were notcertified.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.THE following appointments are notified :-Fleet Surgeon

John S. Lambert to the Excellent. Staff Surgeons : P. E.Maitland to the St. George; C. Strickland to the Jitno;